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Here are some excerpts from this week’s Wall Street Journalarticleexplaining the latest recommendations from the American College of Physicians on the treatment of Back Pain. They list Acupuncture as the top choice for both acute and chronic back pain.

Skip the meds. Lower back pain—one of the most common reasons for a doctor’s visit—is best treated with alternative therapies, say new guidelines from the American College of Physicians. About 80% of adults experience low back pain at some point in their lifetimes and it is the most common cause of job-related disability and a leading contributor to missed work days.

The new guidelines could influence how doctors treat patients with complaints of back pain. They are an update from 2007’s and include a review of more than 150 studies. Recommendations were broken down into acute lower back pain, which is pain lasting less than 12 weeks, and chronic pain, which is pain lasting more than 12 weeks.

For acute pain, the guidelines recommend nondrug therapies first, such as applying heat, massage, acupuncture or spinal manipulation, which is often done by a chiropractor.

For chronic back pain, the guidelines recommend patients also first try nondrug therapies, such as acupuncture, exercise, rehabilitation therapy and mindfulness-based stress reduction.

The reviews focused on improving pain and function If such treatments fail to provide relief, the ACP says NSAIDS should be the first medicine that is used. The third line of treatment should be duloxetine—sold under the brand name Cymbalta and commonly used to treat depression and anxiety—or tramadol, an opioid-like narcotic which is less potent than standard opioids such as oxycodone or fentanyl—but can still cause physical dependence.

Opioids—one of the most commonly prescribed medications for pain relief and a source of increasing addiction and death—should only be considered for chronic back pain when other alternatives—natural and prescription—don’t work, say the guidelines published in theAnnals of Internal Medicine. The new guidelines warn that opioids should only be considered an option if the doctor and patient have a discussion about the known risks of the drugs, and if used at the lowest possible dose for the shortest period. Experts believe that opioid prescriptions for pain is a common gateway to opioid addiction as well as transitioning to heroin, said Steven Atlas, director of practice-based research at Massachusetts General Hospital.

Even acetaminophen, which includes the brand name Tylenol, is no longer recommended for acute lower back pain relief due to a 2014 study in the journal The Lancet that showed it was no more effective than placebo.

Pain can begin abruptly as a result of an accident or by lifting something heavy. More often, though, it develops over time due to age-related changes of the spine and disc degeneration. Most back pain occurs between ages 30 and 50. Individuals who gain weight and don’t exercise have increased risk, as are those who exercise intensely after long periods of not exercising.

If you are in Orlando and have Back Problems call our clinic for a Free Consultation appointment at our Winter Park office to see if Acupuncture can help you! If you live outside of Central Florida feel free to call us for a referral in your local area.

In 1978, Gabe Mirkin, MD coined the term RICE (Rest, Ice, Compression, Elevation). Health care practitioners and laypersons alike are quick to recognize RICE as the ‘gold standard’ treatment for acute injury. All of my patients know that in Chinese Medicine we seldom recommend Ice for any injury. Now the very same physician who coined the term RICE, Dr. Gabe Mirkin, is admitting that there is a lack of evidence to support the therapeutic use of Ice.

Dr. Mirkin describes how ice delays healing in his 3/2014 Article, Why Ice Delays Recovery. “Inflammatory cells rush to injured tissue to start the healing process. The inflammatory cells called macrophages release a hormone called Insulin-like growth Factor (IGF-1) into the damaged tissues, which helps muscles and other injured parts to heal. However, applying ice to reduce swelling actually delays healing by preventing the body from releasing IGF-1.” He goes on to say that, “anything that reduces your immune response will also delay muscle healing. Thus, healing is delayed by: cortisone-type drugs, almost all pain-relieving medicines, such as non-steroidal anti-inflammatory drugs like ibuprofen, immune suppressants that are often used to treat arthritis, cancer or psoriasis, applying cold packs or ice, and anything else that blocks the immune response to injury.”

Why is Ice therapy recommended so often if there is little evidence that it works? Well old habits die hard people, physicians, therapists, and laypersons alike are used to the RICE protocol, and so they continue to use it. The science supports the 3,000 year old Chinese theory that blood flow is the key to health and injury healing. Activities that increase blood flow such as acupuncture, stretching, and exercise improve tissue healing and repair, speeding up healing. Things that that limit blood flow, such steroid and non-steroid anti-inflammatory medications, ice, and compression impair or slow the healing process.

Even the National Athletic Trainer’s Association August 2013 position statement on the management of ankle sprains states that there is “limited” clinical evidence for ice therapy. However, they found stronger evidence that functional rehabilitation, proprioception, and balance exercises improve healing.

So, yes, it seems like “everybody” other than your Acupuncturist recommends ice for injuries. Now you know that “everybody” might not have read the research.